Psychiatry is an extremely fulfilling specialty to work in. It offers many exciting prospects over and above the clinical work such as acquiring new skills and learning new topics, opportunities for management, leadership, research, and teaching skills along with making a tangible impact in the society.
As a Psychiatrist, we learn about psychology, behaviorism, learning theories, emotions, the development of the mind and many more exciting things. We learn the connection between the body and mind and how human beings perceive the world given their individual experiences. We learn how our own thought processes can have a negative impact on us as a person and how to minimize this. We learn how emotions can become overwhelmingly difficult to deal with and how we as psychiatrists can have an impact on the health of a person in such situations. We work with a patient population perhaps most marginalized and stigmatized within society making them furthermore vulnerable. We work with patients detached from reality who themselves are unable to express the distress they are experiencing. We need to have real empathy and understanding and insight into their state. We fight to change the perception of society with regards to mental health bringing with it a huge sense of fulfillment.
Training Pathway at a glance
This figure gives you a general guide of the common training pathway in the UK. There are several points where IMGs can enter this pathway.
Core Psychiatry Training pathway in the UK:
Figure courtesy of RCPsych
Psychiatry training starts with three years of core training for which doctors require full GMC registration, foundation competencies and two years post grad experience.
Prior experience in psychiatry or any part of the MRCPsych exam is not required to enter core psychiatry training, however, it is strongly advisable to show your commitment to the specialty at the interview stage.
A new run-through programme is being trialed in which a Child & Adolescent mental health(CAMHS) trainees are offered ST1 to ST6 post, in a single region.
During three years of core training. trainees will rotate between various sub-specialties of psychiatry and gain a wide range of valuable skills. CT trainees are usually first on-call rotas and gain experience of managing psychiatric emergencies on the front line.
The recruitment for all CT Psychiatry training posts in England, Scotland and Wales is the responsibility of the National Psychiatry Recruitment Office, based within Health Education England’s North West Local Office.
Northern Ireland continues to operate its own recruitment process for psychiatry (http://www.nimdta.gov.uk/)
Medical Training Initiative (MTI) pathway:
MTI is designed to attract limited numbers of International Psychiatry Graduates to experience training in the NHS for up to two years at CT3 level post, before returning to their home country.
Successful MTI applicants are offered GMC registration following their English language requirements along with a two year tier-5 visa.
MTI scheme suits psychiatrists who are experienced practitioners in their home country and does not cater the newly qualified graduates.
Although MTI scheme initially grants a two-year visa, MTI doctors have moved onto different visas afterward to work as staff grades and there are examples of MTI doctors passing MRCPsych membership exams and moving into ST training.
There is an official MTI scheme managed by RCPsych but there are also other organizations involved in recruiting for MTI such BAPIO ( British Association of Physicians of Indian Origin).
For more information please check the RCPsych MTI website page.
Specialist Training and Sub-specialties of Psychiatry:
In my view the three years of Specialist Training (ST) in Psychiatry are the most enjoyable part of training as along with clinical exposure it offers protected time for research, management, and leadership activities. Trainees take the opportunity to grow their confidence and pave the way as potential future leaders for our NHS.
ST trainees are usually second on-call which is non-residential in most places that I know of.
Psychiatry in the UK has several subspecialties and you can obtain a CCT in 6 different subspecialties. These include:
- General Adult Psychiatry (GA)
- Old Age Psychiatry (OA)
- Child & Adolescent Psychiatry (CAMHS)
- Forensic Psychiatry
- Psychiatry of Intellectual Disability (LD)
- Medical Psychotherapy
Sub-specialty endorsements can be achieved during the ST training in the following subspecialties:
- Rehabilitation psychiatry (as part of General Adult Psychiatry)
- Substance misuse psychiatry (as part of General Adult)
- Liaison Psychiatry (as part of both OldAge and General Adult)
There are dual training programmes combining Adult and Old Age Psychiatry lasting four years.
There are clinical fellowship programmers also on offer which are usually a combination of academic and clinical training posts both at CT & ST training level.
Non Training jobs in Psychiatry:
There is a shortage of doctors working in psychiatry and there are plenty of junior level and middle-grade non-training jobs in psychiatry available all across the country. NHS trust advertises these jobs on NHS jobs website on regular basis. The CT equivalent posts are a good start for IMGs as their first job as it gives them the clinical experience of Psychiatry and an opportunity to improve their portfolios in order to apply for core training jobs.
Psychiatry consultant jobs are also undefiled in various geographical areas and therefore doctors achieving go on specialist register usually don’t have any problems finding consultant positions or suitable locum consultant posts.
Treating patients suffering from mental health issues is extremely satisfying. Unfortunately, there are several myths regarding psychiatry include that people with mental illness never recover and there is a chronic course with no hope. Dispelling these myths can pose a challenge at times but equally overcoming them is truly rewarding.
Psychiatry as a career offers an excellent work life balance and time to involve yourself in teaching, research and management activities alongside your clinical role.
Common myths about Psychiatry:
There are several myths about psychiatry and they need to be addressed openly to reduce stigma against mental health.
1. Doctors working with mentally unwell patients experience mental health symptoms themselves.
False. Mental illness isn’t contagious.
In my experience doctors working in psychiatry are more mindful of their own emotions and develop better emotional intelligence and resilience during training.
2. Listening to someone else’s problems all day can cause you stress.
False. Helping others actually gives you satisfaction.
3. The mentally unwell patient never recovers.
False. Many mental illnesses are treated successfully and many patients are discharged from psychiatry services after successful treatment. Some mental illnesses run chronic course but with the advancement of treatment and rehabilitation psychiatry, patients are able to receive appropriate support aiming to live their life to full.
4. Psychiatrist are paid less than physicians or surgeons.
False. Psychiatrist are on the same pay scales during training and non trainings jobs as physicians and surgeons.
Scope of working abroad:
UK- trained psychiatrists are sought after around the world and Membership of Royal College of Psychiatrist is recognized worldwide.
Likewise a CCT in Psychiatry is also very well recognised.
As the key skill of psychiatrist is communication, understanding the native language while abroad can be a key factor for a doctor deciding to move abroad. However, this has rarely prevented successful moves to Canada, Middle East, Australia to name a few.
Scope of Private work:
As a psychiatrist, there are many opportunities in the private sector. Some consultant conduct private clinics. There are private sector organizations managing low and high secure forensic units and rehabilitation units and may on average offer a more attractive remuneration for doctors in comparison to NHS.
There are additional areas of work in out of hours such as Section 12 and DOLS assessments which are paid on average around £175 per assessment (pre-tax).
Some psychiatrist also chose to do medico-legal work and court reports.
Teaching, Research, Quality Improvement and Leadership Opportunities:
There are plenty of teaching opportunities in Psychiatry and these go much beyond medical student teaching. I have seen colleagues teaching in secondary schools about mental health, working with charity organizations, teaching in primary care, general hospitals and multi-disciplinary professionals. There is a need for more mental health training for everyone and you could be instrumental in its delivery.
Psychiatry is at the cutting edge of research in the UK and there are opportunities for undertaking both qualitative and quantitative research. There is ongoing excellent research work in the universities and you can generate numerous opportunities by networking with the academics working within the field of mental health, neurosciences, and Psychology to kick-start your own research portfolio.
Trainees at the CT and ST training level can successfully complete their independent literate review projects and experiment with qualitative research methods.
There are a lot of opportunities to show real leadership which goes beyond your regular clinical role. These include taking initiative and motivating teams, designing service improvement projects, reshaping services, working with charity organizations and make a tangible impact.
For more information on Psychiatry training pathways and recruitment please check the following links.
RCPsych training information:
Central Psychiatry recruitment site:
For upcoming psychiatry training rounds and updates please check the website below.
RCPsych Training curriculums:
I created a Facebook group to provide support for Psychiatrists and I post regular training and non-training opportunities
I am starting to write a blog based on commonly asked questions about psychiatry training in order to help juniors.